3 comments

The actual optic nerve in the right photo is the minute circle of white that barely surrounds the vessels exiting the optic nerve. It is virtually impossible (but as Dr Raab points out, never entirely impossible) that the visual acuity would amount to anything significant. The only way this eye could have 20/50 vision is if that small gliotic white disc was entirely composed of foveal fibers…this seems extraordinarily unlikely. Therefore, choices A, B, and C are UNLIKELY and choice D is MOST LIKELY. This is an excellent example of a “double ring sign” as found in severe cases of optic nerve hypoplasia. The actual optic nerve appears to be the “cup” of a much larger illusionary optic nerve created by the pigment surrounding where the full-sized optic nerve would normally be found. EUA is sometimes needed to fully appreciate this finding in young children.